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Maspero M, Yilmaz S, Joyce D, DeBernardo R, Liska D, Gorgun E, Steele SR, Valente MA. Factors associated with stoma closure after cytoreductive surgery. Am J Surg 2024; 230:47-51. [PMID: 38042719 DOI: 10.1016/j.amjsurg.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND The rate of stoma closure after cytoreductive surgery (CRS) ± hypethermic intraperitoneal chemotherapy (HIPEC) is reportedly low. This study aimed to assess predictors of stoma reversal. METHODS We retrospectively analyzed all patients who underwent CRS with temporary ostomy at our center between 2009 and 2021, and compared reversed versus non-reversed patients. RESULTS Out of 625 CRS, 72 (11.5%) patients were included (median age 62 years, 65% female, 75% with HIPEC): 53 (74%) achieved stoma closure. Reversed patients had less high grade tumors, more appendiceal mucinous neoplasms, less ovarian primaries, and more loop ileostomies. The most common reason for non-reversal was disease progression or death (14 cases, 74%). At multivariate analysis, low/intermediate grade tumor differentiation was associated with higher stoma closure rate. CONCLUSION In our study, 74% of patients achieved stoma closure after CRS with temporary ostomy. The strongest predictor of stoma closure was a low/intermediate grade tumor.
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Affiliation(s)
- Marianna Maspero
- Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Sumeyye Yilmaz
- Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Joyce
- Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert DeBernardo
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - David Liska
- Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emre Gorgun
- Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Steele
- Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michael A Valente
- Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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Vaughn AE, Lyttle BD, Tran W, Derderian SC, Liechty KW, Gien J. Surgical Necrotizing Enterocolitis - Can We Predict the Need for Gastrostomy Tube Placement? J Surg Res 2024; 295:168-174. [PMID: 38016270 DOI: 10.1016/j.jss.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/16/2023] [Accepted: 10/28/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality among extremely premature infants. Approximately 50% of cases progress to surgery, frequently resulting in resection of necrotic bowel and ostomy creation. Premature neonates are at risk for bronchopulmonary dysplasia and feeding failure; surgery in these patients is higher risk. We evaluated the incidence of gastrostomy tube (GT) placement after ostomy reversal in surgical NEC to define a subset of patients who would benefit from concurrent ostomy reversal and GT placement. METHODS A single-center retrospective study of infants with surgical NEC requiring ostomy creation between 2007 and 2021 was performed. RESULTS Eighty patients met inclusion criteria. A GT was placed in 45/80 (56.3%), of which 3/45 (6.7%) were placed before, 20/45 (44.4%) concurrently with, and 22/45 (48.9%) after ostomy reversal. Between those who did and did not require GT placement, there were no significant differences in gestational age (27 versus 27 wk, P = 0.94) or birth weight (830 g versus 1055 g, P = 0.36). Hospital length of stay was longer in the GT group (128.2 versus 70.9 d, P < 0.0001). Time from ostomy reversal to hospital discharge was shorter when performed concurrently with GT (56 versus 77 d, P = 0.02). There were no differences in short-term or long-term GT related complications based on timing of GT placement. CONCLUSIONS GT placement occurred in approximately 50% of patients with surgical NEC and GT may be accomplished safely at the time of ostomy reversal thus reducing the need for an additional procedure.
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Affiliation(s)
- Alyssa E Vaughn
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
| | - Bailey D Lyttle
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Wesley Tran
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - S Christopher Derderian
- Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Kenneth W Liechty
- Division of Pediatric Surgery, Department of Surgery, University of Arizona Tucson College of Medicine and Banner Children's Hospital at Diamond Children's Medical Center, Tucson, Arizona
| | - Jason Gien
- Division of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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Baxter NB, Pediyakkal HF, DeShazor-Burnett LJ, Speyer CB, Richburg CE, Howard RA, Rob F, Thumma JR, Telem DA, Ehlers AP. Outcomes of Emergency Parastomal Hernia Repair in Older Adults: A Retrospective Analysis. J Surg Res 2024; 293:596-606. [PMID: 37837814 DOI: 10.1016/j.jss.2023.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Parastomal hernias are common and many are never repaired. Emergency parastomal hernia repair (PHR) is a feared complication following ostomy creation, yet the incidence and long-term outcomes of emergency PHR are unknown. MATERIALS AND METHODS We performed a retrospective analysis of 100% Medicare claims data (2007-2015) to evaluate complications, readmissions, reoperations, hospitalizations, and mortality after emergency PHR. We used logistic regression and Cox proportional hazard models to determine the association of surgical approach, including repair with ostomy reversal, resiting, mesh, minimally invasive approach, or a myofascial flap. Analysis took place between June 2022 and February 2023. RESULTS A total of 6658 patients underwent emergency PHR (mean [standard deviation] age, 75.9 [9.8] y; 4031 female individuals [60.5%]). Overall, 3433 (51.2%) patients underwent primary PHR, 1626 (24.4%) underwent PHR with ostomy resiting, and 1599 (24.0%) underwent PHR with ostomy reversal. In the 30 d after surgery, 4151 (62.3%) patients had complications and 55 (0.83%) underwent reoperation. Compared to local repair, the 30-d odds of complications were lower for patients who underwent ostomy resiting (odds ratio 0.82 [95% confidence interval 0.72-0.93]). Five y after surgery, the cumulative incidence of reoperation was 12.0% and was lowest for patients who underwent PHR with ostomy reversal (hazard ratio 0.15 [95% confidence interval 0.11-0.21]) when compared to local repair. CONCLUSIONS Emergency PHR is associated with significant morbidity. However, technique selection may influence outcomes. Understanding the prognosis of emergency PHR may improve decision-making and patient counseling for patients living with this common disease.
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Affiliation(s)
| | | | | | | | | | - Ryan A Howard
- Department of General Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Farizah Rob
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Jyothi R Thumma
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Dana A Telem
- Department of General Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Anne P Ehlers
- Department of General Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
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Men G, Lv Q, Wen G. What is the optimal timing of ostomy reversal in infants with necrotizing enterocolitis? Asian J Surg 2023; 46:3855. [PMID: 37005183 DOI: 10.1016/j.asjsur.2023.03.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Guangguo Men
- Neonatal Intensive Care Unit, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China.
| | - Qin Lv
- Neonatal Intensive Care Unit, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
| | - Gang Wen
- Department of Pediatric Surgery, Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
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Rausa E, Kelly ME, Sgroi G, Lazzari V, Aiolfi A, Cavalcoli F, Bonitta G, Bonavina L. Quality of life following ostomy reversal with purse-string vs linear skin closure: a systematic review. Int J Colorectal Dis 2019; 34:209-216. [PMID: 30547183 DOI: 10.1007/s00384-018-3219-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The importance of the defunctioning stoma on minimizing anastomotic leak in colorectal surgery is well established. However, a defunctioning stoma can substantially impact on quality of life (QoL). Circumferential purse-string approximation (PSA) and linear skin closure (LSC) are the most commonly performed surgical technique for reversal of stoma. The aim of this review was to systemically review and meta-analyze available randomized controlled trials (RCTs) comparing PSA and LSC. METHODS An electronic systematic search using MEDLINE databases (PubMed, EMBASE, and Web of Science) of RCTs comparing PSA and LSC was performed. Eight RCTs totalling 647 patients met the inclusion criteria and were included in this meta-analysis. RESULTS Patient's satisfaction is significantly lower in PSA group during the first postoperative week, but it sharply improves afterwards and no difference were noted at 1 and 6 months between the two groups. Relative risk (RR) of developing a SSI is significantly lower in PSA compared to LSC group (RR 0.16 95% CI 0.09; 0.30; p = 0.0001), whereas incisional hernia (RR 0.53 95% CI 0.08; 3.53; p = 0.512), operative time (MD - 0.06 95% CI - 0.30; 0.17; p = 0.593), and hospital stay (MD - 0.09 (95% CI - 0.29-0.11; p = 0.401) remain similar. DISCUSSION QoL was similar in both patients groups after the first postoperative week. PSA significantly reduced SSI rate. No difference was observed in incisional hernia rate, operative time, or length of hospital stay.
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Affiliation(s)
- Emanuele Rausa
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy.
| | - M E Kelly
- Department of Colorectal Surgery, Connolly Hospital, Dublin, Ireland
| | - G Sgroi
- Division of Surgical Oncology, Treviglio Hospital, Treviglio, Italy
| | - V Lazzari
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - A Aiolfi
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - F Cavalcoli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Bonitta
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
| | - L Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy
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Gunnells DJ Jr, Wood LN, Goss L, Morris MS, Kennedy GD, Cannon JA, Chu DI. Racial Disparities After Stoma Construction Exist in Time to Closure After 1 Year but Not in Overall Stoma Reversal Rates. J Gastrointest Surg 2018; 22:250-8. [PMID: 28755086 DOI: 10.1007/s11605-017-3514-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/19/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Conflicting data exist on racial disparities in stoma reversal (SR) rates. Our aim was to investigate the role of race in SR rates, and time to closure, in a longitudinal, racially diverse database. METHODS All adult patients (>18 years) who received an ileostomy or colostomy from 1999 to 2016 at a single institution were identified. Primary outcomes were SR rates and time to closure. Failure to reverse and time to closure was modeled using Cox regression. Kaplan-Meier survival curves, stratified by race, were generated for time to closure and hazard ratios (HRs) calculated. RESULTS Of 770 patients with stomas, 65.6% of patients underwent SR; 76.6% were white and 23.4% were black. On adjusted analysis, race did not predict overall SR rates or time to closure if performed less than 1 year. Instead, significant predictors for failure in SR included age, insurance status, end colostomy/ileostomy, and loop colostomy (p < 0.05). Predictors of delay in time to closure included insurance, end colostomy/ileostomy, and loop colostomy (p < 0.05). In patients who underwent reversal after 1 year, black race was an independent predictor of time to closure (HR 0.21, 95% CI 0.07-0.63, p < 0.05). CONCLUSION SR rates were equal between black and white patients. Disparities in time to closure existed only for black patients if reversed more than 1 year after index stoma construction. While equitable outcomes were achieved for most patients, further investigation is necessary to understand stoma disparities after 1 year.
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